Neurological Assessment

Strict spine precautions, including immobilization, should be maintained until full clinical and radiographic evaluations have been completed. A detailed neurological examination should be done as early as possible during the initial evaluation, with time and date recorded. It is important that, in the awake patient, both motor and sensory function of all extremities be assessed. Grading of muscle strength and sensation to pinprick and light touch need to be recorded using the American Spine Injury Association (ASIA) system. Patients who are unconscious should have their muscle tone, muscle stretch reflexes, long tract signs and priapism in the male patient documented initially. A rectal examination to test sphincter tone, quality of contraction, presence or absence of the bulbo-cavernous reflex and the anal wink, as well as perineal sensation also, should be part of the initial evaluation.

Placement of a nasogastric tube, as well as a Foley catheter, should also take place in the emergent phase of treatment. This is done since it is common for these patients to develop a paralytic ileus, which places them at risk of aspiration of gastric contents. Not only is the Foley catheter helpful for recording urinary output, but also to prevent bladder distention that frequently accompanies the urinary retention experienced by these patients.

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.